The board of Community Health Center of the Black Hills has made an offer on the Sam's Club building in Rapid City, which will be vacant after a new Sam's store is completed near Interstate 90.

"We have made an offer to Wal-Mart on the building, and that's where it stands," board president Ron Reed said. "We're in limbo right now just waiting for a decision from Wal-Mart."

The existing Community Health facility, across La Crosse Street from Sam's Club, is "absolutely jammed to the gills," Reed said. "We just can't squeeze any more patients into the space we currently have."

Currently, that space totals about 8,000 square feet in two buildings, Reed said. Medical services lease space in a building owned by Rapid City Regional Hospital. Dental services are housed in a separate office nearby.

Chief executive officer Crystal Jordan said Community Health treats about 12,000 patients each year. Total patient visits reached a high of 45,000 in 2006, and she expects to see similar numbers this year.

"There's a really high demand for our services, and we could bring on more physicians to provide care to these people who are in need but we don't have the space," she said. "There are services that … our patients are going without because we don't have the space."

In particular, "We would love to be able to provide mental health services. Depression is one of our most often diagnosed conditions," Jordan said.

Community Health has five physicians, one nurse practitioner, two part-time pediatricians and two pediatric nurse practitioners on staff, as well as two dentists and one dental hygienist. The work load is significant: Patients must schedule three to four weeks ahead to see a doctor and four to five months ahead to see a dentist, Jordan said.

Community Health does operate an acute care clinic to serve walk-in patients with more urgent medical needs. Dental patients who need quick attention can come to the clinic and hope a dentist can see them between appointments.

"A lot of times, walk-ins will start lining up for the dental clinic at 7 a.m.," Jordan said, even though the clinic doesn't open until 7:30 a.m.

Most of Community Health's patients are from Pennington and Meade counties, but Jordan said they also see people from Lawrence, Butte, Custer, Fall River, Jackson, Jones and Haakon counties, as well as from western Wyoming.

Nearly 50 percent of Community Health patients are uninsured, Jordan said. No one is turned away because they can't pay, but Community Health is not a free clinic. It operates on a sliding-fee scale.

Still, "sometimes it's difficult to get payments from those patients (who are supposed to pay more) also, just because times are hard for everybody," Jordan said. "Even if you don't qualify for a discount, that doesn't mean that your annual income is enough to support medical care, which is expensive."

Community Health was formed in 1992 by Rapid City and Pennington County, Reed said, but those entities don't provide much funding. About $2 million of the facility's approximately $5 million budget comes from federal funds designed to cover the discounts provided to uninsured patients.

"But that grant has been pretty much stagnant for the past couple of years," Jordan said. "Our costs are going up, and the number of uninsured that we see is steadily increasing. So that money doesn't go as far as it used to."

Community Health provides more than just basic medical and dental care. They operate satellite clinics at Cornerstone Rescue Mission, Salvation Army and Working Against Violence Inc., or WAVI, and a satellite pediatric clinic across town. Reed said they hope to open a medical/dental clinic at General Beadle School this fall.

They also offer various ancillary services, such as a nurse who works with diabetic patients and two full-time employees who organize medication for uninsured patients and help patients apply for free medication from pharmaceutical companies. Jordan said the federal government and other funding sources also want them to expand case management and work on preventing health disparities. All those things require space.

And according to a market assessment performed by Capital Link - a national consulting firm that works with community health centers on large capital projects - the need for services isn't going to slow down anytime soon.

"They're projecting that by 2012 we'll have about 17,000 users and that by 2015 we'll have about 19,000 users," Jordan said. "Right now they're expecting (we'll) need about eight family practitioners."

There's plenty of room in the Sam's Club building. The existing store is 115,000 square feet, according to assistant manager Michael Hahn. They expect to move into the new, larger store in the next 12 to 18 months.

Reed said several other local agencies are interested in sharing space in the Sam's Club building with Community Health. He didn't identify the agencies but said many would serve the same clients.

Community Health's medical, dental and pediatric services would all move to the new building if the deal goes through. Outreach sites would continue to operate, Reed said.

"It'll be a good location for us," he said. "We're looking forward to it."

Contact Heidi Bell Gease at 394-8419 or heidi.bell@rapidcityjournal.com